Telephone-based COACHing reduces cardiovascular risk factors

A statewide, telephone-based coaching program has been shown to reduce risk factors for cardiovascular disease and type 2 diabetes in both indigenous and non-indigenous Queenslanders.

In a paper published in today's issue of the Medical Journal of Australia, researchers have shown that the introduction of centralised statewide coaching by Queensland Health using the well-regarded COACH (Coaching patients On Achieving Cardiovascular Health) Program (TCP) had statistically significant improvements in cardiovascular risk factor status.

The improvements were found across all biomedical and lifestyle factors measured during the program, including improvements in serum lipid levels, blood glucose, smoking and alcohol consumption combined with increases in physical activity. There was no significant difference in results between the indigenous and non-indigenous patients.

The COACH program has been used for many years in all states and territories and was first developed by the University of Melbourne's Margarite Vale in 1995. It is also widely used by private health insurers.

It was introduced by Queensland Health in 2009 and is delivered by nurses through its Health Contact Centre. It is available to all eligible patients in Queensland irrespective of where they live.

As the researchers write, TCP is a standardised coaching program delivered by telephone and mail-out for people with or at high risk of chronic disease. The nurses coach people to achieve national guideline-recommended target levels for their particular risk factors and to take their medications as recommended.

Referral to the Health Contact Centre for participation in TCP is accepted from public hospitals, GPs, medical specialists, cardiac rehab services, Quitline and self-referral.

The patients do not meet the coaches in person – although Queensland Health has been trialling it by video conference for indigenous people living in remote areas – and is mainly aimed at patients who cannot or will not attend cardiac rehab.

It uses customised web-based software for program delivery and evaluation, which records all relevant patient and risk factor details. It also generates structured patient letters and contains all key performance indicators including patient uptake, completion rates, achievement of risk factor targets and adherence to recommended medications at entry to and exit from the program.

The MJA study, led by Chantal Ski from the Centre for the Heart and Mind at the Australian Catholic University, audited 1962 patients with coronary heart disease (CHD) and 707 with type 2 diabetes who completed TCP between February 2009 and June 2013, of which 145 were indigenous Australians.

Measurements included changes in fasting lipids, fasting glucose, glycosylated haemoglobin levels, blood pressure, body weight, body mass index, smoking, alcohol consumption and physical activity.

The results showed statistically significant improvements in cardiovascular risk factor status in patients with CHD and/or type 2 diabetes, including improvements in serum lipids, blood glucose, smoking habit and alcohol consumption.

Associate Professor Ski said the exclusive use of telephone and mail-outs was unique to the chronic disease management model adopted by Queensland Health.

“A further point of difference is that coaches identify the ‘treatment gaps’ in each patient’s management – the gaps between guideline recommended care and the care patients actually receive, and coach patients to close their treatment gaps whilst the patients work with their usual doctors,” she said.

“These methods eliminate barriers often seen with cardiac rehabilitation programs, including geographic isolation, travel costs and the inconvenience of appointments.”

She said the results provided further evidence to support the program as an effective strategy for reducing cardiovascular risk and for secondary prevention.

“As our cohort comprised patients with CHD and/or type 2 diabetes, the results suggest the potential for TCP to be adapted for other chronic diseases,” she said.

Posted in Australian eHealth

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